NR 535 Week 6 Assignment: Develop an Evolving Case Study

Evolving Case Study Chamberlain University NR 535 Theoretical Foundations & Instructional Strategies for the Nurse Educator NR 535: Theoretical Foundations and Instructional Strategies for the Nurse Educat ...

Evolving Case Study Chamberlain University NR 535 Theoretical Foundations & Instructional Strategies for the Nurse Educator NR 535: Theoretical Foundations and Instructional Strategies for the Nurse Educator Template for Week 6 Assignment Overview of Evolving Case Study • Purpose • Identify type learner • Learning objectives • Description of the case study and the setting • The purpose of this case study is to educate new graduate RN, BSN orientees who have been newly hired to a telemetry step down unit on the care of a patient with heart failure. • At the end of this case study the learner will be able to interpret diagnostic testing indicative of heart failure. • At the end of this case study the learner will be able to identify complications related to undiagnosed hypertension. • This case study will take place in groups of 3 within a classroom setting at the hospital in which the nurses have been newly hired. Description of Patient Name Donald Duck Gender/Age/Weight/Height Male/52y/220lbs/5’11” Allergies PCN Past medical history Gout History of present illness Presented to ER with complaint of headache with blurred vision with onset approx. 2 hours prior to arrival at ER unresolved with Tylenol and Motrin. Brought to ER by spouse. No PCP Social history Married x 30 yrs, 2 adult children, works full time in construction, smokes 1ppd x 25 yrs, social drinker 5 drinks per week Primary medical diagnosis Malignant HTN Surgeries and/or procedures with dates Appy approx. age 7, choly 2009 Report that Learners receive to prior start of the Evolving Case Study using SBAR Format Time of report 07:00 Person providing the report Amanda RN Situation Patient presented to ER by private vehicle accompanied by spouse with complaint of headache and blurred vision at 22:30. Background Patient has not been seen by a PCP in greater than 5 years. Patient reports increasing number of headaches over the last 2 months. Assessment B/P in ER 238/126, HR 96, R 24, T 97.6, SpO2 96%. Lung sounds clear, HR regular, no edema present, Clonidine 0.3mg administered in ER at 23:20. No chest pain or shortness of breath reported. Telemetry monitor placed in ER. Recommendation Patient admitted to unit at 03:30 for blood pressure monitoring and cardiac workup. Patient made comfortable upon arrival. 20g IV in left hand @ TKO, telemetry monitor in place with normal sinus rhythm. Clonidine 0.1mg ordered every 6 hours for B/P >160/90 and O2 @ 2L/NC PRN. V/S at time of admission to unit 168/84, HR 82, R 20, T 97.4, SpO2 97%. Labs drawn in ER with the following results: H/H 12.1/36.0, CK 34, CKMB 1.8, Trop 0.02, BUN 35, Creat 1.8 Evolving Case Study Progression Stage One (Start of the case study) Evolving Case Study Information to be presented to the Learner Actions Learners Should Demonstrate Critical thinking questions Nothing is needed in this column Patient sitting on side of bed leaning forward on bedside table in tripod position. Accessory muscles being used for respirations Assessed heart and lung sounds, vital signs and placed O2 on patient 1. What factors could be contributing to the sudden onset of shortness of breath? 2. How could the patient’s long term smoking habit contribute to the current shortness of breath? Trigger for Stage Two: During assessment patient reported he has difficulty lying in bed and has been sleeping in the recliner for approx. 2 months. Called MD with new orders for CBC, CMP, BNP, chest x- ray, EKG, troponin, CK, CKMB and echo Stage Two: Deterioration in fictional patient’s health status Evolving Case Study Information to be presented to the Learner Actions Learners Should Demonstrate Critical thinking questions Nothing is needed in this column Patient sitting upright in bed with oxygen in place. Audible crackles noted with respirations. 2+ pitting edema noted to BIL lower extremities from toes to knees. Assess heart and lung sounds, vital signs. Heart sounds noted to be distant and lung sounds noted to have fine crackles throughout all fields. Elevated lower extremities. Reviewed diagnostic tests. Chest x-ray revealed cardiomegaly. Lab values revealed 1. What is the effect of cardiomegaly on pulmonary function in a patient with heart failure? 2. How does the patient’s lifestyle contribute to CHF and malignant HTN? BNP of 867. Echo revealed 30% heart function. Trigger for Stage Three: Cardiologist rounded on patient with new DX of CHF and orders for Coreg 3.125mg BID, Lisinopril 10mg q day, Lasix 40mg BID, KCL 20meq q day. Patient instructed to establish with a PCP and to follow up with cardiologist 1 week post discharge. Stage Three: Stabilization of fictional patient Evolving Case Study Information to be presented to the Learner Actions Learners Should Demonstrate Critical thinking questions Nothing is needed in this column New orders discussed with patient and spouse who expressed concern over the medications and doctor appointments due to limited health insurance. Spouse reports that patient eats fast food most days and has been resistant to stopping smoking. Patient educated on CHF including diet. Medication education provided. Consulted with social worker for assistance with medications and insurance. Smoking cessation programs discussed with patient. 1. What are the long-term consequences to the patient if he does not fill the medication or follow up with doctor appointments? 2. What is the long-term expected outcome to the patient if he follows up with doctor appointments and fill his medication but does not make lifestyle changes? Debriefing Critical thinking question for holistic nursing care What is the best source of support to patient and spouse to promote a healthy lifestyle? Critical thinking question for ethical element With inadequate health insurance, how will the patient follow the prescribed treatment plan without the ability to pay for what is required? Explanation of the nurse educator’s role during the debriefing Nurses should be examining the whole picture of the patient. Debriefing allows the nurse educator an opportunity take the information learned and expand upon the learner’s responses to expand their thoughts beyond the immediate situation. Explanation of how debriefing contributes to learning by the target audience Debriefing allows the learner to talk through the case study with the educator to examine all aspects. Performing the activity in small groups allow the learners to learn from each other during the debriefing session. Self-Reflection Identify how an evolving case study reflects your educational My learning philosophy is that learning should be led by the student with the educator guiding the path. The use of an evolving case study allows the learner to think critically about a situation without the answers being given to them. The use of an evolving case study pushes the student to put all of the information together to best meet the needs of the patient. philosophy Identify how does the use of critical thinking questions reflect your educational philosophy Learning should be learner led. Application of critical thinking questions requires the learner to look at the situation to determine the best course of action. The educator is only providing the scenario, the learning is carried out by the student through the use of critically thinking through the scenario.